Case Manager I (Prior-Authorization Nurse)
Centene Corporation - Manchester, NH

This job posting is no longer available on Centene Corporation. Find similar jobs: Case Manager jobs - Centene Corporation jobs

This position will be with Granite State Health Plan, a subsidiary of Centene Corporation.

Position Purpose:
Review requests for prior authorization of medical services such as surgeries, pain management, home health care.

At least two years clinical nursing experience. Experience utilizing medical management software programs.

Position Responsibilities:
  • Review provider requests through fax or telephone to ensure medical necessity for services requiring preauthorization.
  • Utilize nationally recognized criteria to determine medical necessity of services requested.
  • Refer provider requests appropriately to Medical Director when medical necessity of services is not met based on the criteria.
  • Act as a clinical resource to referral staff
  • Act as a liaison between the Provider and the Medical Director
  • Data enters authorizations into the system.
Licenses/Certifications: RN, LPN or LVN required. Current state nursing license.

About this company
194 reviews
Centene is sensitive to the needs of individuals and families enrolled in government-assisted health programs. The company provides managed...